The Lyons Manor

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

220000318 Issued in CA

Legal business name

THE LYONS MANOR

Practice address

1102 Lyons St
Redwood City, CA 94061-2263

Phone

(650) 299-0738

NPI assigned

Mar 31, 2008

Organization subpart

Yes

Parent organization

YTR HOMES ICF/DD-H INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Yolanda Torres Ruiz

Title

Licensee/Cfo

Phone

(650) 299-0738

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G885

Legal name

LYONS MANOR ICF

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jul 10, 1995

Last certification

Oct 25, 2024

Beds

6

Ownership / control type

Private (proprietary)

Facility address

1102 Lyons Street
Redwood City, CA 94061

Tax ID family

James Court Manor3 organizations share this tax ID, including this one

Part of

James Court Manor

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Casa Nova Icf/DD-H

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • San Mateo, CA
  • NPI 1982876702
  NPD tax ID
• James Court Manor

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • San Mateo, CA
  • NPI 1730351545
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1912179805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 LYONS ST",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940612263",
            "telephone_number": "650-299-0738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 LYONS ST",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940612263",
            "telephone_number": "650-299-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LYONS MANOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YTR HOMES ICF/DD-H INC",
        "enumeration_date": "2008-03-31",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_middle_name": "TORRES",
        "authorized_official_title_or_position": "LICENSEE/CFO",
        "authorized_official_telephone_number": "650-299-0738",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "220000318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC 60665F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.